胰腺损伤术后胰瘘相关危险因素分析

目的:探讨胰腺损伤术后胰瘘发生的危险因素。方法:回顾性分析2000年3月—2013年11月收治的胰腺损伤行手术治疗的59例患者的临床资料,按照胰瘘的诊断标准分为胰瘘组与无胰瘘组,并对围术期可能与胰瘘有关的8个因素进行单因素分析,将两组间差异有统计学意义的因素纳入Logistic多因素分析,探讨胰腺损伤术后发生胰瘘的独立危险因素。结果:59例患者术后发生胰瘘24例,发生率40.7%,其中胰外瘘18例,胰腺假性囊肿6例。单因素分析显示伤后至手术时间、淀粉酶变化增高趋势、胰腺损伤级别3个因素两组间比较差异有统计学意义,将上述3因素纳入Logistic多因素回归模型中,进行Logistic多因素分析,保留在Logistic多因素回归模型中的因素为伤后至手术时(OR=6.654),胰腺损伤级别(OR=8.393),术后引流液淀粉酶变化呈增高趋势(OR=12.883)。结论:伤后至手术时间≥12 h,胰腺损伤级别为Ⅲ级或Ⅲ级以上,术后淀粉酶值变化呈增高趋势是胰腺外伤术后胰瘘发生的独立危险因素。

Analysis of risk factors for pancreatic fistula of patients with pancreatic trauma

Objective：To discusse the risk factors of pancreatic fistula after operative management of pancreatic trauma. Methods：Fifty - nine patients of pancreatic trauma received operative management in the second clinical hospital of shanxi medical university, from March 2000 to November 2003 was analyzed. Eight single risk factors for pancreatic fistula of perioperative period were univariate analyzed, and the independent risk factors for pancreatic fistula of perioperative period were screened and included in a multivariate Logistic regression for analysis. Results：All of the 59 patients, the pancreatic fistula was 24（40.7% ）, and pancreatic external fistula occurred inl8 of patients, and pancreatic pseudocyst occurred in 6 patients, single factor analysis showed that, the time between injury and operative, and increased value of amylase of fluid drainage, and the degree of pancreas injury was significantly different between two group. The above three of factors have been introduced into the multiple factors Logistic models which shows that the time between injury and operative ≥ 12 h （ OR = 6.654）, the degree of pancreas injury exceeding class Ⅲ （ OR = 8. 393 ）, increased value of amylase of fluid drainage （ OR = 12. 883 ） were independent risk factors for pancreatic fistula. Conclusion：the time between injury and operative ≥ 12 h, the degree of pancreas injury exceeding class Ⅲ,increased value of amylase of fluid drainage predict a high probability of pancreatic fistula after operative management of pancreatic trauma.